Shawn Vestal: Mann-Grandstaff VA Medical Center shortens wait times

As the VA has begun closely auditing wait times across the nation, some concrete figures about access to care at Spokane’s Mann-Grandstaff VA Medical Center have emerged.

The Spokane hospital has one of the longest Electronic Waiting Lists in the country – indicating new patients who could not be scheduled for appointments within 90 days. It also has more veterans who’ve been on the EWL for more than 120 days than almost any other hospital in the country. But the audits – conducted every two weeks – also show that the Spokane hospital is trimming its EWL and moving more patients into treatment quickly over the past several weeks. The hospital says it is making “tremendous progress” on shrinking the EWL.

The audits indicate that the Spokane hospital is scheduling 86 percent of new patients for appointments within 30 days; that is lower than the national average of 90 percent.

The new figures also reveal that in some cases, at least, certain audit figures overstate actual delays. The VA is now tracking wait times in two ways: By looking at hospital schedules and estimating availability for future appointments, and by looking backward at actual wait times. The “prospective,” or estimated future, wait times were consistently longer than the actual wait times – sometimes much longer.

For example: Audit figures released Thursday show that a new patient seeking mental health services at the Spokane VA would have a prospective wait time of 59 days. An audit conducted two weeks earlier had found a prospective wait time of 58 days. The VA’s target for mental health appointments is 14 days or less.

But when the VA auditors tracked the retrospective – or actual – wait times of new mental health patients at the Spokane VA in the month of April and May, they found wait-time averages of 10 and 11 days, respectively. Prospective waits for primary care and specialty care were also longer than the actual waits. The same pattern held in the audited figures for hospital after hospital.

Dr. Quinn Bastian, head of behavioral health services at the hospital, said part of the reason for that discrepancy in his department may be that the scheduling system has open times built into it for psychiatrists and staffers to respond to questions, take care of drop-in patients and handle other unforeseen duties. Someone looking ahead would see those times as simply unavailable, when in fact patients are seen during those blocks.

The VA has been keeping a close eye on wait times since the national controversy erupted earlier this year following allegations that the Phoenix VA hospital was cooking the books to hide its long waits for service. Subsequent national audits have exposed systemic and long-standing problems with treatment for veterans, including widespread delays for treatment that have, in some cases, resulted in deaths. Meanwhile, record keeping at many hospitals has obscured these waits – all while the majority of VA administrators have continued to receive performance bonuses.

Bastian said the controversy and subsequent fallout has produced some positive steps for the treatment of veterans. For one thing, he noted, the wait times for mental health services are no longer a performance measure used to evaluate administrators – helping to remove a potential incentive to put a shine on disturbing numbers. But that’s being done in combination with an effort to get more veterans care outside the VA system if the waits are too long. Bastian said the hospital has “new opportunities and authorizations” to seek care from other providers in the community when the VA can’t respond quickly enough.

It’s clear that problems of access for veterans remain, as the figures for Spokane’s EWL indicate. New patients who cannot be scheduled for appointments within 90 days are placed on the list.

The latest audit shows that 1,210 veterans are on Spokane’s EWL. And 373 of them had been on the list for more than 120 days. Both of those figures are among the largest of any VA hospital in the country.

But they are also significantly smaller than the figures from just two weeks prior – when the EWL was at 1,543.

In brief written answers to questions about the audits this week, the Spokane VA said that part of the reason for the EWL numbers was that the hospital is “experiencing staff vacancies in some programs.

“However, through the accelerated care initiative” – the nationwide push to speed up access for veterans – “we have made tremendous progress having patients on the EWL seen sooner.”